Telehealth barriers in public health and strategies to address them

Updated: Mar 16

Telehealth is "the delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services, and self-care via telecommunications and digital communication technologies" (NEJM Catalyst, 2018).

There are many advantages to telehealth. Some patients are homebound due to disabilities or conditions and can't get to the doctor's office. Others live in remote areas where comprehensive health services, like psychological care and chronic disease management, aren't available or convenient. Telehealth makes it possible to reach these individuals who might otherwise delay or forego care entirely.

But despite its broad reach and capabilities, there are barriers to implementing telehealth in rural communities. Explore a few of them below.

Internet access

In rural communities where there are already fewer comprehensive health services available, there is also a shortage of reliable and accessible broadband internet. Because of the high-capacity needs of telehealth communication services, strong broadband is required to use telehealth services effectively. The alternative is video and conference calls that glitch, disconnect, or lag. In rural America, 24% of residents said that access to high-speed internet was a "major problem in their community" (Vogels, 2018).

Partnering with community organizations and businesses that have reliable internet access is one strategy to address this barrier. Even in remote and rural communities, there are public libraries, cafes, and other businesses. These organizations typically have reliable internet access to run effectively. Recognizing this, many libraries in rural communities have already partnered with public health teams, medical offices, and physician organizations to facilitate telehealth within their organization (Chiricuzio, 2022).

Community trust

Rural communities have values that run deep. And one of those values is community and relations (Farmer, 2010). Telehealth brings providers and doctors from different areas of the state, or even the country, into the space of rural communities. For communities that generally feel more comfortable with people they know, this can be a barrier to using telehealth.

One solution to this issue involves education. Currently, most medical colleges are located in urban areas or cities. Many medical students end up staying in a city setting to practice medicine after graduation. But there have been multiple efforts in higher education to create more residencies and placements in these rural communities for medical students.

Beyond medical school, another solution is using Community Health Workers (CHWs) in these communities. CHWs are frontline public health workers and trusted community members who belong to the communities they serve. This belonging generates more trust and respect between the CHWs and their clients. CHWs in rural communities can work with their clients to build client and community trust in medical professionals located outside of that community. They can also help patients navigate the telehealth system and generate the knowledge base needed to use it effectively.

Next steps

If your practice is trying to implement telehealth in a rural community, consider forming meaningful partnerships with the organizations and businesses in that community. And if possible, reach out to CHWs in that community, or create a CHW position in your organization that can work with that community. These strategies can make rural telehealth implementation much easier and more effective. For any assistance with these strategies, reach out to the team at Everyday Life Consulting. We've worked with multiple organizations to successfully facilitate telehealth in their communities.

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